Enrolment Form

The purpose of this form is to collect essential information for your enrolment with Macquarie Training Limited. Please ensure all sections are completed accurately to allow your enrolment to be processed.

Alternatively you may print this form to fill in manually and post in to us.

Please Note: Areas marked with an asterix (*) are compulsory.

National Student Number or NZQA Number
If you know your National Student Number (NSN) or NZQA number, write it here:
 

Personal Details
* Mr   Mrs   Miss   Ms   Other
Family Name * Maiden Name
Given Name(s) * Preferred Name
Alternative Name(s)
Date of Birth * * Male   Female
 

Address Details
Company 
Name *		 Company Phone *
Company Address * Company Fax
Mobile
Email *
Occupation * Post Code *
Manager's Name Industry Sector
 

Statistical Information for NZQA Reporting *
NZ European/Pakeha NZ Maori Cook Island Maori Samoan
Tongan Tokelaun Fijian Other Pacific Island Groups
Chinese Indian Other Asian Groups Other
If other please specify below
 

Special Needs *
Do you live with the effects of a significant injury, long term illness or disability? Yes   No
If "Yes", my disability affects me in the following ways:
Hearing Specific Learning Physical/Mobility Medical
Visual Speech    
Temporary    
Any Special Dietary Requirements    
 

Course Enrolment Details *
Course Date Location Price ($)
Includes GST
PAYMENT TERMS: PAYMENT IN FULL REQUIRED PRIOR TO COURSE ATTENDANCE.
   
 

Payment Options *

Macquarie Training offer the following payment options:

  • Cheque
  • Corporate Account
  • Direct Credit Payments to - ANZ - 01 0373 0036460 00
Cheque Posted - made payable to Macquarie Training Limited
Direct Credit Payment - ANZ - 01 0373 0036460 00
Corporate Account (as below)
Purchase Order

PLEASE ADVISE YOUR ACCOUNTS DEPARTMENT OF OUR PAYMENT TERMS
PLEASE EMAIL ME YOUR QUARTERLY NEWSLETTER
 

Declaration *

I hereby apply to be enrolled in the programme/course(s) on this form and confirm that I have read the Terms & Conditions of Enrolment and Privacy Act information accompanying this form, and understand and accept them. I also confirm that the details I have supplied, particularly my name, date of birth and address are true and correct. I understand that if this information is subsequently found to be false, my enrolment may be cancelled and I will be liable for any costs incurred by Macquarie Training Limited in cancelling my enrolment.

 
Name Date Read our Terms & Conditions

I Agree  (In order to send this enrolment form you must agree to the Terms & Conditions)



Mailing: PO Box 11318 Papamoa 3151 Physical: 89 Domain Road Palm Beach Papamoa 3151 Copyright © 2012 Macquarie Training Limited
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